Welcome

Welcome to the POZ/AIDSmeds Community Forums, a round-the-clock discussion area for people with HIV/AIDS, their friends/family/caregivers, and
others concerned about HIV/AIDS. Click on the links below to browse our various forums; scroll down for a glance at the most recent posts; or join in the
conversation yourself by registering on the left side of this page.

Privacy Warning: Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If you are HIV positive
and disclose this in our forums, then it is almost the same thing as telling the whole world (or at least the World Wide Web). If this concerns you, then do not use a
username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.

The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own
physician.

All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.

Forums members must behave at all times with respect and honesty. Posting guidelines, including time-out and banning policies, have been established by the moderators
of these forums. Click here for “Am I Infected?” posting guidelines. Click here for posting guidelines pertaining to all other POZ/AIDSmeds community forums.

We ask all forums members to provide references for health/medical/scientific information they provide, when it is not a personal experience being discussed. Please
provide hyperlinks with full URLs or full citations of published works not available via the Internet. Additionally, all forums members must post information which are
true and correct to their knowledge.

Author
Topic: Does the Dentist need to know? (Read 10151 times)

I've just finished 3 years of orthodentic treatment and have just finished today the Endodontic treatment and now have to have a bridge fitted and then have some cosmetic work done. (YES, it does feel like I have a BMW in my mouth or at least I feel like I have paid the prie of a BMW to sit in my mouth)

I am not on meds so just wondering if any of you have any advice on whether one should tell their dentist on HIV status or is it a personal matter. All dentists take full protection with their patients anyway, so it is probably not relevant.

I am one of those who avoided the dentist for many years. I finally went in this past December because Advil no longer controlled the toothache. I was really nervous about the HIV issue. I'd convinced myself that the dentist was going to refuse service to me due to my status. It is a crazy thought, and it might not even be legal to do so in the U.S. I completed the medical history form and I checked "yes" next to HIV. I was apprehensive about it, but felt somewhat courageous that day I guess. When I met the dental assistant she asked when I last had blood tests, what my CD4 count was and whether i was on antiretrovirals. When the dentist came in I noticed that the assistant pointed out something on my chart. I assume it was the HIV status, but to be fair, she could have been pointing out my T Cell count, the fact that I had not been to a dentist in 6 years or that I have insurance. I have no idea. During our "getting to know you talk," he mentioned my good CD4 count. He told me that he looks for all kinds of things in every patients mouth, but that he'd be on the look out for anything unusual. For some reason he put me at ease. While he wore all of that stuff during the demolition work, he took it off to talk to me, he touched my shoulder to indicate he understood something that I said. I was so afraid that I'd be treated like radioactive waste and it turns out that he is probably the best dentist I've ever seen.

I told my friend Sharon about the experience. She is also poz, she thought I was crazy for telling. Her perspective is that they all use universal precautions and that informing the dentist that she is poz will only make him nervous and more likely to make a mistake or cause more pain when he working on her mouth. I think that is in interesting point-of-view, one that I had not considered. I'm interested in others' opinions.

The reason I tell my dentist is so that he (or she) can look a little more closely for the beginnings of infection, gum disease, or tooth decay. Because with an impaired immune system, what someone else might shrug off could be dangerous to me.

Frankly, I disclose not for his safety, but so that I get the extra care I need. There are OIs which manifest in the oral cavity as well, and sometimes knowing my HIV ststus makes the diff between a dentist disregarding stuff and treating me for something. It's certainly saved my teeth on more then one occasion

Last time I went to the dentist, they said I had the teeth of an eighteen year old. I replied that the rest of him was on back-order <grin>

I'm a little weird about my teeth, because I had braces as a kid. I floss twice a day, use teeth whitening stuff, minimize coffee and red wine, all that stuff. Personally, were I you, with the money and effort you have put into your teeth, I would disclose. Be a shame to have gum disease or simple gingivitis take all those teeth because your immune system had bigger fish to fry, right?

Logged

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

I told my dentist about my HIV status when I started going to him about 10 years ago and no one in his office batted an eye. They ask me the usual questions about medication changes when I go for my check ups and that is about it. One time my dentist told me I had some white areas on my throat that my MD should look at, which turned out to be thrush. My opinion is if a dentist has a problem with my HIV status I do not want him or her working on my teeth.

For me, I had decided to tell my main dentist as I felt that the main people involved in my HIV with me are the people who will assist me in preventing OI's etc, namely my doctor, dentist and HIV specialist. Everyone will ahve personal reasons for informing or not. However, I feel that anyone that can assist ME, by eing informed SHOULD be informed especially if it will benefit me.

I think my dentist was the first one to suspect I was HIV+. I was having a problem with my gums (severe gingivitis) just after my summer of infection. He asked me if I had the Crohn disease or any other immune condition, but never pointed out HIV. He gave me an antibiotic. I had to repeat the treatment 3 times until my gums recovered. Now my gums and teeth look very nice. I have never had any cavities, tooth extractions or anything. I have all my teeth intact!

It’s my belief that it is to my advantage that any health care provider knows exactly my HIV status. My dentist is great. He’s gay and knows the special needs of one with a compromised immune system. I feel very comfortable with the care I get from him and his staff.

don't forget your eye doctor too It seems less obvious but anyone who provides me medical services (including vision checks) should know. ...and not for any moral standpoint, but to ensure I get the best care possible.

I've never met a dentist that disclosed his/her status to me before treatment.That said...I prefer that any dentist treat me as if I am infected, and as if he or she were infected.I also think routine cleanings and x-rays are one thing, and extractions, root canals, and oral surgery are quite another.

It is not written, that you have to inform your dentist, of your status. However, I don't have a problem with that. I have had the same dentist for close to 20 years. He is aware of my HIV. A few years back, I had Hernia surgery, and notified the surgeon also. He thanked me, and everything went as scheduled. My dermatologist, also knows of my status, and once again, no problems as a result of it.

Universal precautions are taken today to help prevent doctors, dentists from becoming accidentally infected. Once again, if you are not confortable at informing your dentist, that is you parogative.

Yes, you should disclose your status to your dentist, eye doctor, and anyone else that provides you health care. Not for their safety, but so they can provide the best care they can for you. They cannot legally deny you care. Of course, if they seem not to want to treat you, then change providers. If they don't enough about HIV to know they can treat you safely, you don't want them as a provider anyway - and they don't deserve your money !!

Yes, they all take universal precautions and treat everyone as though they carry a bloodborne pathogen. If you really, really don't feel comfortable disclosing, that is certainly your prerogative. But if someone gets a sharps injury while providing you care, they are going to whisk you away that very day for an HIV test - and not just ELISA and Western Blot, but DNA PCRs and RNA PCRs as well (just in case you are in the window period), as well as tests for Hep A/B/C. They get these results, the local health department gets involved if the results are positive, the provider goes through post-exposure prophylaxis, and everyone gets pissed at you for not telling your status in the first place. This will certainly color any relationship you may have with your provider.

Evidence of OIs often present in the oral cavity before anywhere else. Some, like thrush, primarily present in the oral cavity. Kaposi's will often present in the oral cavity first. Some conditions, such as gingivitis, may be treated more aggressively in an HIV patient. Certain procedures should probably be avoided during periods of low CD4 counts, or covered with prophylactic antibiotics. If you are to be sedated by an oral surgeon or any other provider, they need to know if you are on Norvir, which limits the amount of sedatives such as Versed or Halcion which may be used.

Anesthesiologists need to be told, especially if you are on meds. Again, Norvir is the primary culprit, due to it's tendency to increase the half-life of many of the drugs anesthetists use.

HIV causes changes in the retina at the back of the eye, as well as in the vitreous. Your eye doctor needs to be looking for these things. It won't hurt him not to know, but not telling him may work against you in the long term. When he sees the cotton-wool areas that often form in the back of your eye, his first question will be whether you have developed diabetes. Then he's probably recommend an HIV test - it really is that specific. They can look into your eyes and tell if you are poz.

If you don't have a provider that you feel comfortable telling about your status, then change providers to someone that you can feel comfortable with. Go out of town if you must, but find someone somewhere you can be truthful with. You will get better care.

wow, aint that something! thanks - i totally did not know this. now i know this might sound gory/graphic but i truly would like to see that - y'know, the back of an HIV+ eye through ophthamologic equipment ..... but it will likely freak me out. i don't care. i still wanna see.

I thought about this for awhile before going. I felt it important for all my Dr's to know my status, since they are taking care of my wellbeing. Given the fact that HIV/AIDS & the meds used can effect gums recessions etc. I felt it important. I have an extremely knowledgeable doctor and when I told him he just laughed and said "get your ass in here for your cleaning and about another couple hundred ahead of you (you think your the only one don't you? not by a long shot Eric". He hugged me on the way out the door. Me and the tooth cleaning gal talked about this.

She actually had a scare awhile back when a patient who did not disclose til later when she put her arm down, she inadvertently landed on one of the instraments that cleaned his teeth causing a deep puncture through her protective gear. She was told after the fact about his AIDS diagnosis and she had to go through allot with preventative treatment and all (3 months of worry). Maybe if he told her, she would have been even more cautious and this may not have happened. She was so glad when I told her my status. We talked a very very long time and she was proud of me for allowing me to disclose to her and the dentist. I realize a puncture would probably be a "bleed out" of infection, but would you take that risk yourself if you were -ve?

Same goes for the eye doctor. There are certain problems HIV/AIDS patients have to deal with with their eyes. I will tell this doctor as well when the time comes to go..

These are all fine and dandy when you live in a world that's not stigmatized about HIVAIDS.. I will not go to a doctor who has problems with my condition.

I have been living with HIV since 1994. Yes the dentist is required to utilize personal protection gear, laws have changed since 1994. I was instructed in my first support group to tell medical providers, "I am HIV positive, I am telling you this for your safety and the safety of your staff. If any of this information is put on my records, there are serious legal repercussions, do you understand?" I have never had a problem.

Thinking about that dental assistant, they have to stand or sit for hours each and every working day in uncomfortable positions, without the benefit of proper ergonomics and is the most likely to be injured because she or he has to lean over, in the most uncomfortable positions known to modern civilizations, be ready to vacuum blood and hand dentist any number of given tools upon request. Of the three people in the room, this person is the most likely to be injured and possibly infected by the bloodborne pathogen, we've come to call HIV, the virus that causes AIDS. That is my personal opinion, I was a safety expert until AIDS with a 10 year anniversary on Saturday. Reading the responses on this topic will be very interesting. Have the best dayMichael

HIV Retinopathy. Cotton wool spots. Found in HIV infection, Diabetes, Systemic Hypertension, and Central Retinal Vein Occlusion. Visible in 50-70% of HIV positive patients. The spots are smaller in patients with HIV than in patients with the other conditions. Here's a link to a picture:

I was under the impression that you legally HAVE to disclose your HIV status to a dentist or anyone else that does a medical procedure. Is this right? Luckily, my local clinic provides routine dental care so disclosure isn't an issue, and any decent ASO should be able to refer you to a dentist that is cool with HIV+ patients.

As for the Optometrist, I don't. Reading an eye chart in no way puts anyone at any risk. I was a little nervous during the last exam, because I had heard about the Cotton Wooly patch thing and if she had seen anything unusual I decided that I would tell her but everything was fine. I have the eyes of an 18 year old....wait make that eyes FOR 18 year olds...

My dentist also emphasised the importance of exceptional dental hygene for HIV pos patients since even something simple like gingivitis can wreak havoc with someone with a weakened immune system.

Logged

"Fortunately, I Keep My T Cells Numbered For Just Such An Emergency" -Either Foghorn Leghorn or Johnny Cash

In the ordinary course of life events, you will likely have occasions to visit different doctors and other healthcare professionals, sometimes for health matters that are not related to your HIV infection. Of course, your primary care physician needs to know about your HIV status. With others healthcare providers you have more of a choice. All medical providers are supposed to be taking "universal precautions," which means special procedures to protect themselves against any transmissible infection, not just HIV. For instance, there's no particular reason your podiatrist needs to know. But in the case of your optometrist or your dentist, while you're not legally bound to disclose, by having that information he or she may be able to identify certain health problems.

Healthcare providers cannot deny their services to someone simply because the person is HIV-positive. If a doctor or other healthcare provider is uncomfortable treating someone with HIV and lets that be known in whatever way to you, you do have legal recourse in such situations. No less important is that a healthcare provider who's fearful of an HIV-positive patient is not one who should be seeing HIV-positive patients.

As far as disclosure of your HIV-related information is concerned, bear in mind that it's generally permitted only after you have signed an approved special HIV release form.

General tips to consider with regard to medical and healthcare providers:

All healthcare providers are bound by confidentiality laws. By telling a doctor, a nurse or other healthcare providers, you do give up a degree of privacy, but that does not release them from adhering to laws regarding confidentiality. Sometimes treating your status as privileged information is not as scrupulously observed as it should be. If, for instance, a doctor's employee discusses details with you that another patient might overhear, politely request that such conversations be discussed in private. A hospital or other healthcare provider may share HIV information with a patient's insurance company if the information is necessary to pay for medical care. If you're in doubt about whether you have to reveal your status for either medical or insurance purposes, or indeed legally for any other reason, call your local Department of Health or AIDS service organization. In some instances you may learn that it's necessary to disclose in order to have access to medical resources and services "

Thanks J,The Disclosure section of the Lessons is probablly the only one I haven't read ( will read through it in a sec.) I'm still shy about revealing my status and I was burned once by a Doc who clearly didn't want me as a patient.

Logged

"Fortunately, I Keep My T Cells Numbered For Just Such An Emergency" -Either Foghorn Leghorn or Johnny Cash

HIV Retinopathy. Cotton wool spots. Found in HIV infection, Diabetes, Systemic Hypertension, and Central Retinal Vein Occlusion. Visible in 50-70% of HIV positive patients. The spots are smaller in patients with HIV than in patients with the other conditions.

I recently went to a new dentist who advertised in a local gay publication. I disclosed my status to the dental hygienist who was going to clean my teeth. she nervously excused herself and left the room. The dentist then came in and nervously told me that he would clean my teeth. He was in a hazmat suit with a helmet and face shield. He gave my teeth a very quick cleaning. As I left the office I noticed that the office staff were staring at me like I was a monster. It was very uncomfortable. I almost wish I hadn't disclosed my status. What a draining experience....

That is a reaction out of the stone age.....but I think you did the RIGHT thing in disclosing yur HIV status as its important for yur dentist to know as well as your doctor. I mean...otherwise how could they effectively treat you. dentists are supposed to LOOK for HIV related problems!!!!

I disclose to my doctors, dentist, opthomologist, etc. The one provider I have some issues with are massage therapists. They want to know your medical conditions and medications and I don't always disclose. I understand they need to know if I have an injured elbow or history of surgery but I don't see why they need to know about my HIV status when I'm healthy. Also I've been to massage therapists who like to talk and I don't care to discuss my CD4 count while I'm trying to relax. And, no, I don't go to "happy ending" massage places...

Ford, if your massage therapist is 'gifted' he will feel it, body language don't lie, the mouth does. The most important thing a massage therapist should know ,is that he is surposed to listen , not talk about himself. If u go to this person regularly & when u trust him, tell him helps as then he can work on another level. Stress does strange things to the body. but if one is looking for 'a happy ending' type of massage that's another thing.

I had a slightly uncomfortable situation--I'd gone to high school with my exceptional dentist who was also a friend. As much as I didn't want to give up his skill level, it was cutting a little too close to home. I knew I wasn't required legally to disclose to him, but ultimately, I made the decision to switch to a dentist recommended by my + medical team. She is just terrific! First time I've ever seen a female dentist. Early after diagnosis, I decided that anyone who could benefit me medically, be it PCP, ophthamologist, chiropractor, massage therapist, acupuncturist, psychologist, etc. would be told--otherwise, I was preventing them from being top notch practitioners and not availing myself of optimal care. And, to date, I've never sensed any discomfort from any of them, in fact, quite the contrary---they seem extraordinarily interested in how I'm doing and keeping me healthy. To peacefully add another perspective, having read DingoBoi's post, I believe what he wrote was very clear and was in no way dismissive of his caregivers' potential (minimal at best given SOP for dentists) for harm.